Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy.
Italian National Research Center on Aging (INRCA), Research Hospital of Cosenza, Italy.
J Gerontol A Biol Sci Med Sci. 2018 Sep 11;73(10):1363-1369. doi: 10.1093/gerona/glx211.
Functional decline from preadmission to admission may represent an important predictor of functional trajectories during hospitalization among older patients. Therefore, we aimed at describing the impact of preadmission decline on functional trajectories among older hospitalized patients.
Our series consisted of 2,011 patients aged 65 years or more consecutively admitted to four acute care wards of Geriatric Medicine participating to a multicenter observational study. Enrolled patients underwent comprehensive geriatric assessment (CGA) by Inter-RAI Minimum Data Set. Main outcomes were functional decline or improvement from hospital admission to discharge based on Activities of Daily Living (ADL) scale. The main exposure variable was ADL decline during the preadmission period (ie, 3 days before the onset of acute illness), and its impact on functional trajectories during stay was investigated by Cox regression models after adjusting for potential confounders.
After adjusting for potential confounders, preadmission functional decline was significantly associated with functional improvement during stay (hazard ratio [HR] = 6.65; 95% confidence interval [CI] = 5.01-8.84), but not with functional decline. Severe cognitive impairment (HR = 0.28, 95% CI = 0.13-0.60), visual impairment (HR = 0.60, 95% CI = 0.41-0.89), and weight loss (HR = 0.67, 95% CI = 0.47-0.94) were associated with functional improvement during stay. Hearing impairment (HR = 1.94, 95% CI = 1.17-3.23) and mild (HR = 2.54, 95% CI = 1.41-4.58) or severe cognitive impairment (HR = 2.72, 95% CI = 1.13-6.56) were associated with functional decline during stay.
Patients experiencing recent preadmission functional decline should be considered as those for which the geriatric approach may lead to the better functional result in the acute care setting. CGA allows to individuate risk factors to be addressed in the acute care setting.
从入院前到入院期间的功能下降可能是老年患者住院期间功能轨迹的重要预测指标。因此，我们旨在描述入院前下降对老年住院患者功能轨迹的影响。
我们的研究系列包括 2011 名年龄在 65 岁及以上的患者，他们连续入住参与多中心观察性研究的老年医学科的四个急性护理病房。入组患者接受了由 Inter-RAI 最低数据集进行的综合老年评估 (CGA)。主要结局是基于日常生活活动 (ADL) 量表从入院到出院的功能下降或改善。主要暴露变量是入院前期间的 ADL 下降（即急性疾病发作前 3 天），并通过 Cox 回归模型在调整潜在混杂因素后调查其对住院期间功能轨迹的影响。
在调整潜在混杂因素后，入院前功能下降与住院期间的功能改善显著相关（风险比 [HR] = 6.65；95%置信区间 [CI] = 5.01-8.84），但与功能下降无关。严重认知障碍（HR = 0.28，95%CI = 0.13-0.60）、视力障碍（HR = 0.60，95%CI = 0.41-0.89）和体重减轻（HR = 0.67，95%CI = 0.47-0.94）与住院期间的功能改善相关。听力障碍（HR = 1.94，95%CI = 1.17-3.23）和轻度（HR = 2.54，95%CI = 1.41-4.58）或严重认知障碍（HR = 2.72，95%CI = 1.13-6.56）与住院期间的功能下降相关。
经历近期入院前功能下降的患者应被视为老年方法可能导致急性护理环境中更好功能结果的患者。CGA 允许确定在急性护理环境中需要解决的危险因素。
